Individual
KEVIN LEE JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
743 OLD NORCROSS RD, LAWRENCEVILLE, GA 30046-4317
(770) 513-1763
(770) 513-2199
Mailing address
743 OLD NORCROSS RD, LAWRENCEVILLE, GA 30046-4317
(770) 513-1763
(770) 513-2199
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
28794
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00435058D
—
GA
Enumeration date
09/25/2006
Last updated
04/10/2014
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